Chinese type drug shortage: domestic basic drugs or discontinued due to low profit

Chinese medicine shortage: the disappearing tabazol, a life-saving drug for hyperthyroidism patients, costs less than 2 yuan for 100 tablets in a bottle, which is unprofitable, so that manufacturers and hospitals are out of stock Recently, many readers reported to this magazine that the domestic basic drug tabazol, which is used to treat hyperthyroidism, has almost stopped production due to no profit After an in-depth interview, our reporter learned that in addition to the hype and hype on the price of drugs in short supply, the shortage of tabazol relied on by hyperthyroidism patients has exposed the embarrassing situation of cheap basic drugs in China at present: enterprises give up production, pharmaceutical companies refuse to sell, and hospitals are reluctant to prescribe drugs Patients who are struggling to find good medicine can only be forced to buy more expensive imported medicine to meet the demand Sun Wu (pseudonym), a native of Suzhou, was found suffering from hyperthyroidism in the first people's Hospital of Zhangjiagang City in April this year The doctor gave him a box of "Saizhi" of about 33 yuan per box But when he returned to Suzhou for further treatment, he found that he could not buy the medicine At the beginning of July, Sun Wu joined a QQ group of nearly 1000 people called "hyperthyroidism super group" In this group, he found that many people all over the country were seeking "Saizhi" "If you want, 100 yuan for each box, plus 15 yuan for express delivery," a netizen with goods told him The general name of Saizhi is methimazole tablet, which is an imported drug produced by Merck "Saizhi" is so popular, the reason is that the basic drug of hyperthyroidism, tabazol (methimazole tablets), which is produced in China, has been gradually discontinued China Economic Weekly recently visited several large pharmacies in Shanghai and found that domestic tabazol has been out of stock for more than two months Wang, a director of the Endocrinology Department of Zhengzhou No.1 People's Hospital, posted on the Internet on July 2, saying: "every day, patients or colleagues ask how to do if methimazole (tabazol, Saizhi) can't be bought?" "There was a problem with the supply of domestic methimazole in the second half of last year, and it was cut off in February this year," Wang told China Economic Weekly Since the end of last year, our hospital had to switch to Saizhi, but three months ago, Saizhi began to be out of stock According to the insiders, the retail price of tabazole is 1.8 yuan, 100 tablets per bottle, 5mg / tablet The reporter contacted a sales person of a domestic pharmaceutical company as a consumer, who revealed that there are still stocks in Beijing, and the price of each bottle is 28 yuan "If you buy more than 10 bottles and don't need an invoice, it can be cheaper." "In China, there are at least several million hyperthyroidism patients The main two basic drugs for hyperthyroidism are tabazol and propylthiouracil tablets, but the latter is not as effective as tabazol, and has certain side effects on the liver, so the scope of use is very small At present, domestic tabazol has been out of stock for 3 months, and only imported "Saizhi" is used " Shi Bingyin, vice president of the First Affiliated Hospital of Xi'an Jiaotong University and director of the Department of Endocrinology, told China Economic Weekly The concept of "essential drugs" was put forward by the World Health Organization in 1977 It refers to drugs that can meet the needs of basic medical and health care, with appropriate dosage forms, guaranteed supply, equipped at the grass-roots level and fair access for the people In China's basic medical institutions, some basic medicines with good quality and low price are often out of stock But "similar to tabazol, the suspension of production is very serious and prominent," Shi Bingyin told China Economic Weekly: "if the production of essential drugs for other diseases is stopped, there can be other alternative drugs, but hyperthyroidism patients can only rely on tabazol or imported" Saizhi " The main reason for the suspension of production is low profit Through searching the website of the State Food and drug administration, 18 enterprises (including API and non tablet enterprises) were found to produce the drug The reporter contacted the above enterprises one by one, and found that in addition to Qilu Pharmaceutical Co., Ltd., which produces ointments, which claims to be still producing and selling, other enterprises have stopped production Most enterprises in Beijing, Shanghai, Guangdong and other places have said they have stopped production for two or three years For a long time, the pharmaceutical companies that look at the face of hospitals and pharmacies for production think that the hospitals are also responsible for this situation The low profit is one of the main reasons for the discontinuation of the drug Under normal circumstances, a bottle of 100 tablets of methimazole is only about 2 yuan, which can be taken by a patient for one to two months "Our pharmaceutical factory depends on the look of the hospital and drugstore Doctors are like salesmen Because it's cheap, so the recommended dosage of this medicine is also small, which leads to poor sales volume Naturally, no one produces it " "The hospital is allowed to get 15% of the profit from the price of patients' medicines Do you think the profit from selling 30 yuan of Saizhi or 1 yuan of 8 yuan of domestic medicine hospitals is greater?" explained a pharmaceutical factory salesman Another major reason for manufacturers to stop production is the shortage of APIs API refers to the raw materials used in the production of various preparations, which are the effective ingredients in preparations Only when the raw materials are processed into pharmaceutical preparations, can they become medicines for clinical application According to the Sales Department of world trade Tianjie Pharmaceutical (Jiangsu) Co., Ltd., it is precisely because the price of APIs has been rising that the enterprise has stopped production since the beginning of this year If the price of APIs drops, it may continue to organize production The same is true for Guangdong South China Pharmaceutical Group Co., Ltd., which has stopped production of methimazole for two years "A customer asked us for this medicine, but we couldn't produce it because we couldn't buy the API." A manager surnamed yuan told China Economic Weekly Only three enterprises in Beijing in China are qualified to produce methimazole APIs, namely tongjida pharmaceutical, Taiyang pharmaceutical and Beiwei pharmaceutical At present, in addition to tongjida pharmaceutical's reply to China Economic Weekly that "preparations for APIs are under way and production is expected to resume soon", other two companies have said that they no longer produce APIs from a few years ago Among them, Beiwei pharmaceutical clearly stated that it had been shut down for about two years due to environmental protection problems The upstream of API production belongs to chemical industry, and it is easy to be forced to stop production due to environmental pressure "For example, if you produce too many varieties of drugs in a month and discharge too much pollutants, the enterprise will cut the production varieties according to the profit contribution degree to reduce emissions Then methimazole is cut just because of the low profit." An insider told China Economic Weekly In addition, enterprises that produce APIs need to obtain GMP certification, which requires enterprises to invest a lot of money to improve the plant facilities and production environment However, if the API manufacturers feel that the production is "uneconomical", they may not apply for GMP certification after 5 years of certification The production of cheap drugs should be supported "with the rise of various costs, the profit margin leads to the production stoppage of various manufacturers The state should take those cheap drugs with good efficacy as public products and give appropriate subsidies to the manufacturers." Shi Bingyin told China Economic Weekly that "he hoped that the pharmaceutical regulatory authorities could keep the basic drugs with good quality and low price, regulate the drug price according to the correct laws of the market, and solve the problem of medical treatment for the common people."   In response to the current drug shortage reported by hyperthyroidism patients, the State Food and Drug Administration forwarded a message through Sina Real Name certification microblog on July 3, saying: "the national health and Family Planning Commission, together with the State Food and drug administration, the national development and Reform Commission and other relevant units, has recently studied and solved the problem of methimazole shortage, decided to take the lead in the implementation of raw material supply and production by Beijing food and drug administration, and is expected to send it to China within 10 days 18 million tablets (5mg) will be supplied in the market, and 60 million tablets will be supplied within 20 days to ease the contradiction between clinical supply and demand Beijing food and Drug Administration told China Economic Weekly that it has been in urgent production with high quality and quantity, and will inform the public when the drugs are put on the market Nevertheless, some insiders are not satisfied with the slow response of the regulatory authorities "The regulatory authorities should have a good understanding of the varieties circulating in the market Only after the shortage of tabazol is so serious and everyone calls for so long can they take action." Some people complained to China Economic Weekly On July 16, the person in charge of the production department of Yanjing Pharmaceutical Co., Ltd told China Economic Weekly that the factory has been producing finished products in succession, "the API is supplied by tongjida, tongjida will continue to do API business, and the listing of tabazol is just a matter of time".